Analytics 101

Deron Ferguson, PhD Director, Performance Measurement & Analytics

July 29, 2015

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Objectives

• Define analytics

• Re-define analytics

• Provide basic principles of good

analytics practice

• Address barriers to good practice

• Outline steps to establish analytics

• Discuss an example application

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What is Analytics?

“The systematic computational analysis

of data or statistics” (Google)

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Analysis vs. Analytics

Research and Analysis Dr. John Snow’s path-breaking

Cholera study (ca. 1854)

Analytics CDC’s Waterborne Disease and

Outbreak Surveillance System

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Some Observations

Measurements are usually well-established

“Data gathering” is not trivial

(especially in health care)

Analysis is mostly automated

Reporting should be concise

Dialog with users is essential

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Is Analytics the Silver Bullet? (Hype Cycle source/credit: Gartner.com)

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Barriers to Healthcare Analytics (KPMG survey of health care leaders)

0 10 20 30 40

Data in silos, not standardized

Lack of technology

Lack of skills

Organizational culture

Cannot capture or exchange data

Unclear ROI

% Responses

Leading barriers:

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What is Analytics?

“The systematic computational analysis

of data or statistics” (Google)

Maybe a better definition would be:

“The positioning and coordination of

people, tools, and techniques so that

organizations can systematically

leverage data assets for discovery,

improvement, and innovation”

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Facets of Analytics Practice

Analytics

Practice

Data

Warehouse

Quality

Improvement

Engineers

Documentation

Hardware /

Software

Data

Sources

Researchers Information

Designers

Organizational

Alignment

Reporting

Systems Analytics

Engineers

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Versions of Truth >1 ? Members from the management team need reports for their

presentations for the upcoming board meeting. The organization does

not have an analytics data warehouse, so analysts must access

production databases designed for claims processing (not analytics).

Mary

There is no standard method, so Mary creates a query on the

encounters database and builds a report for the Executive Director,

who then shares it with the management team.

Peter

The CFO wants more detail, so she asks Peter to add some

subgroups that weren’t in the original report. The subgroup totals

don’t sum to Mary’s total, so Peter writes his own query, slightly

different from Mary’s, to get an internally consistent report.

Paul

Meanwhile the new analyst, Paul, creates yet another report for the

Quality Director, however, he does not know to exclude inactive

records because there are no standards or clear data dictionaries.

= 4 Resulting versions of “truth”! (3 reports + actual truth)

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Recap

• Analytics is an organizational practice:

• Decision makers must prioritize analytics

• Most everyone plays a role (like it or not)

• Top barriers in healthcare analytics:

• Data quality, availability

• Organizational alignment

• First steps building analytics practice:

• Plan Data model Manage data

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Degrees of Sophistication (another nice chart from Gartner.com)

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Production versus

Ad Hoc Analytics

• Production analytics is usually automated

• Focus on standardized measurement

• Should have quality controls!

• Ad Hoc is semi-automated

• Focus on exploration

• Requires a dedicated, documented data

warehouse or data marts

• Need more than just access to data systems

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Analytics in Small Organizations

• Technology is only part of analytics

• More important is organizational practice…regardless of size of the organization

• small data is as useful as Big Data • A practice level EHR could be a useful

source of small data – the key is organizing it for easier analysis

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Big Data or small data?

• Don’t skip your analytics plan and data model • Does not have to be complicated

• Data must be: • Correct – must reflect reality

• Complete – “null” values are usually NOT “zeros”

• Current – depends on end use

• Consistent – agreement among sources

• Documented – or else data is nearly useless

• Data management centrally coordinated • Strive for a common version of the truth

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Where does your analytics

bandwidth go? Weak analytic practice: Strong analytic practice:

No value added Value added

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Where Can Analytics Help?

Think of the Triple Aim:

• Improve patient experience

• Healthcare processes and outcomes • Surgical or disease specific improvement; improving

satisfaction; improving readmission rates, etc.

• Improve population health • Chronic condition management; vaccination rates;

nutrition; anti-smoking efforts; use of preventive care

services

• Reduce costs through quality • Improve efficiency, reduce LOS, staff stability etc.

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Analytics Use Cases in a Medicaid

Environment

• Program costs are often driven by a small proportion of

patients with multiple health conditions, often exacerbated by

mental illness, substance use disorders, cognitive limitations or

functional impairments

• High-cost clients are often served in multiple Medicaid-

funded delivery systems (medical, long-term care, mental

health, substance abuse, developmental disabilities)

• High-cost clients often have significant social support needs

such as the need for housing or employment support, or

interventions to reduce the risk of criminal justice involvement

• Persons dually eligible for Medicare and Medicaid comprise

a disproportionate share of high-risk, high-cost Medicaid

beneficiaries

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Example Analytics Application:

PRISM

• Predictive Risk Intelligence System

• Integrates multiple WA State data sources

• Sources internal and external to DSHS

• A longitudinal view of Medicaid clients

• Good resource for detailed background

research, identification of subgroups

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Multiple Data Sources

School Outcomes Preschool – College

Internal

Arrests Charges

Convictions

Incarcerations

Community Supervision

Dental Services

Medical Eligibility

Hospital Inpatient/ Outpatient

Managed Care

Physician Services

Prescription Drugs

Hours

Wages

Housing Assistance

Emergency Shelter

Transitional Housing

Homeless Prevention and Rapid Re-housing

Permanent Supportive Housing

Public Housing

Housing Choice Vouchers

Multi-Family Project-Based Vouchers

External

Administrative Office

of the Courts

Employment Security

Department

Department of Corrections

Washington State Patrol

Department of Commerce

Health Care Authority

Housing and Urban

Development Public Housing

Authority

WASHINGTON STATE

Department of Social and Health Services

Integrated Client Databases

Nursing Facilities

In-home Services

Community Residential

Functional Assessments

Case Management

Community Residential Services

Personal Care Support

Residential Habilitation Centers and Nursing Facilities

Medical and Psychological Services

Training, Education, Supplies

Case Management

Vocational Assessments Job Skills

Child Protective Services

Child Welfare Services

Adoption

Adoption Support

Child Care

Out of Home Placement

Voluntary Services

Family Reconciliation Services

Institutions

Dispositional Alternative

Community Placement

Parole

Food Stamps

TANF and State Family Assistance

General Assistance

Child Support Services

Working Connections Child Care

DSHS Juvenile

Rehabilitation

DSHS Economic Services

DSHS Aging and Long-Term Support

DSHS Developmental

Disabilities

DSHS Vocational

Rehabilitation

DSHS Children’s Services

Child Study Treatment Center

Children’s Long-term Inpatient Program

Community Inpatient Evaluation/ Treatment

Community Services

State Hospitals State Institutions

Assessments

Detoxification

Opiate Substitution Treatment

Outpatient Treatment

Residential Treatment

DSHS Behavioral Health and Service

Integration Mental Health and Substance Abuse Services

Education Research Data

Center

De-identified

Births

Deaths

Department of Health

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PRISM Data Sources and Features

• Data sources

Medical, mental health and LTSS services from multiple IT systems

Medicare Parts A/B/D data integration for dual eligibles

Long Term Services and Supports functional assessments

Housing status (including some local jail stay data) from the state’s

eligibility data system

• Data refreshed on a weekly basis for the entire Medicaid population

• Dynamic alignment of patients to health plans and care coordination

organizations, with global patient look-up capability for providers

• 1,000 currently authorized users

• 700,000 page views in past 12 months

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PRISM Users

• PRISM is used by:

Medical and behavioral health managed care organizations

Area Agencies on Aging

Health Home lead entities and their care coordination

networks

• Business associate agreements and PRISM-related contract

amendments govern external contracting entity access to PRISM

• PRISM risk score is a key criterion defining eligibility for Health

Home services in Medicaid State Plan Amendment

• Medicare integration supports provision of Health Home services

for Medicare/Medicaid “dual eligibles”

• Agreement with CMS gives state access to share of Medicare

savings if Health Homes reduce Medicare costs

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Crime

Geography

Family

Health

Services

Work

Demographics

Housing

School

Arrests Convictions

Misdemeanors

Felonies

Incarcerations

Community Risk Factors

County

Legislative District

Urban/Rural

Locale Births

Deaths

Relationships

Siblings

Diagnoses

Pain

Chronic Conditions

Mental Illness

Primary Care

Hospitalization

Medications

Substance Use

ED Visits

Disability

DD

TANF

SNAP

Child Welfare

Medical

Behavioral Health

Long Term Care

Juvenile Rehab

Employment

Unemployment

Hours

Earnings

Language Age

Gender Race/Ethnicity

Homeless

Stable

Progress

Grades

Graduation

Test Scores

Special Needs

Stability Attendance

Multiple Dimensions of Measurement

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Some Uses of PRISM

• Quality Improvement

• Analysis of care transitions or coordination

• Analysis of disparities and barriers to care

(housing, physical impairments, language)

• Identification of psychotropic medication

polypharmacy patterns associated with

overdose risk

• … and probably many others.

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More Uses of PRISM

• Identifying Needs

• Child health risk indicators for high-risk

children (mental health crisis, substance

abuse, ED use, nutrition or feeding

problems)

• Behavioral health needs (redacting

information where required by state or

federal law)

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Even More Uses of PRISM

• Delivering the right services

• Triaging high-risk populations to better

allocate scarce care management

resources

• Informing care planning and care

coordination for clinically and socially

complex persons

• Identification of potential narcotic drug-

seeking behavior

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Longitudinal View

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CLOSE-UP

Visibility to

sources of

risk

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CLOSE-UP

Drug

Adherence

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On the Healthcare Analytics Horizon

• Real-time Analytics

• Cross-setting care management

• Integration with social media and “apps”

• Predictive Analytics

• Improving diagnoses, use of genomic info

• Manage medications (reduce risk, side effects)

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Take Home Points

Analytics can be described as:

“The positioning and coordination of

people, tools, and techniques so that

organizations can systematically

leverage data assets for discovery,

improvement, and innovation

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Take Home Points

• Analytics is more than just a “department” in

your organization

• Begin with a plan and a data model

• High quality “small data” is valuable

• Small HCOs don’t need a huge investment

• Take stock and build a plan

• Build analytics into workflows

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Deron Ferguson

Director, Performance Measurement and Analytics

deronf@qualishealth.org

206-288-2431

For more information: www.QualisHealth.org

Questions?